Transcription of DIVISION OF MOTORIST SERVICES COMPLAINT AFFIDAVIT
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DIVISION OF MOTORIST SERVICES COMPLAINT AFFIDAVIT
FOR OFFICIAL USE ONLY TYPE OF COMPLAINT Motor Vehicle Dealer Mobile Home Dealer Mobile Home Manufacturer RV Dealer/Manufacturer Odometer Fraud Other Date Opened: _____ Date Closed: _____ Closing Code: _____ COMPLAINT #: _____ Investigator: _____ COMPLAINANT INFORMATION Name: _____ Date of Birth: _____ E-mail Address: _____ Address: _____ City/County/State/Zip Code: _____ Home Telephone Number: _____Work Telephone Number: _____ FAX Number: _____ Driver License/ID Number (In lieu of FL DL/ID, an Out)
COMPLAINT AFFIDAVIT _____ Page 2 . DESCRIBE THE NATURE OF YOUR COMPLAINT: Please explain your complaint, listing events in the order in which they occurred.
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